Basic Information
| Provider Information | |||||||||
| NPI: | 1558478701 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEREJNOI | ||||||||
| FirstName: | KIRILL | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 SHERIDAN RD | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049373314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078615000 | ||||||||
| FaxNumber: | 2078615001 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 SHERIDAN RD | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049373314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078615000 | ||||||||
| FaxNumber: | 2078615001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 12/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | EC081003 | ME | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 432679799 | 05 | ME | MEDICAID | NONE | 01 | ME | RESIDENT-NO PROV # | OTHER |